Epilepsy affects nearly three million Americans, approximately 30% of whom continue to suffer in spite of more than 20 antiepileptic drugs (AEDs) currently available, while the only potential cure – epilepsy surgery – is offered to only one out of 35 of those whose life it may change drastically by possibly making them free of seizures. One of the reasons for this discouraging situation is the lack of reliable localising information regarding an epileptic focus that would make it a safe target for surgical removal.
Localization of epileptic foci in patients with medically-uncontrolled epilepsy (those who failed three or more AEDs) is currently the most frequent clinical indication for magnetoencephalography (MEG) or magnetic source imaging (MSI). Numerous published clinical studies (for instance, Sutherling et al, 2008; Knowlton et al., 2008a, 2008b) provided ample evidence for the usefulness of MEG in providing non-redundant (otherwise unavailable) localizing information in potential surgical candidates. This prompted the American Clinical Magnetoencephalography Society (ACMEGS), a professional society of physicians and other professionals with doctoral degrees “involved in clinical use of magnetoencephalography(MEG)” (ACMEGS,Inc, Bylaws, 2006) to propose its 1st Position Statement regarding “the value of magnetoencephalography (MEG)/magnetic source imaging (MSI) in noninvasive presurgical evaluation of patients with medically intractable localization-related epilepsy” (Bagic et al, 2009). Subsequently, the American Academy of Neurology (AAN) published its supportive Magnetoencephalography (MEG) Policy (pdf) that is now taken as an additional strong endorsement by many insurers who are increasingly changing their negative coverage policies to positive because of the synergistic evidence-driven efforts of the ACMEGS and AAN.
As powerful a technology as MEG is, it is important to realize it is neither useful nor indicated in diagnosing epilepsy or guiding non-surgical treatments.
According to the highest standards of care for patients with epilepsy, each patient with epilepsy who fails 2 antiepileptic drugs (AEDs) should be referred to the major epilepsy center for an evaluation for refractory epilepsy. University of Pittsburgh Comprehensive Epilepsy Center (UPCEC) is a level IV NAEC (National Association of Epilepsy Centers) Center that offers the highest level of epilepsy services available.
The UPMC MEG Epilepsy Program has experience and expertise in studying the most complex cases of epilepsy and will gladly guide referring physicians through the process of ordering an indicated MEG study, precertification or preauthorization with the insurance (if required), and advise on subsequent best use of the results.
Having a vagus nerve stimulator (VNS) is not an obstacle for having a MEG study at our MEG Program.
All ordering physicians and patients whom we’ve served since 2005 have found it very beneficial that our MEG epilepsy studies are interpreted by an epileptologist who treats epilepsy patients daily..
Anto Bagic, MD, PhD